Inpatient rehabilitation for traumatic brain injury (TBI) has been studied largely as an undifferentiated black box. Research has not addressed which specific therapy interventions or medical procedures are effective for specific types of patients and impairments. This project proposes to open the black box of acute rehabilitation for individuals with TBI and create sophisticated, outcomes-based tools for clinical decision- making. This 5-year study will use Clinical Practice Improvement (CPI) methodology to characterize rehabilitation therapy services for 1,815 individuals with moderate to severe TBI and evaluate effects of these therapies on TBI rehabilitation outcomes, controlling for differences in patient characteristics and severity of injury and illness. CPI isolates specific components of rehabilitation treatments to determine how, and to what degree, each component is associated with outcomes. Three primary outcomes addressed are: (1) extent of functional improvement;(2) discharge to a private residence (versus nursing home, hospital, other institutional setting);and (3) resources reflected in length of stay. This is a collaborative research partnership among nine geographically and demographically diverse hospital-based TBI rehabilitation facilities and the ISIS Institute for Clinical Outcomes Research. Detailed, daily documentation of interventions performed in each therapy session, medical procedures delivered including medications and surgeries, nursing interventions, and psychosocial services will be recorded for a patient's entire acute rehabilitation stay. Standardized documentation that reflects current practice and existing research will be developed by clinicians and researchers from the participating centers. Specific aims of the proposal and relevance to.public health are: Aim 1: Identify individual patient characteristics, including demographics, severity of brain injury, and severity of illness (complications and comobordities), associated with significant variation in outcomes. Aim 2: Identify medical procedures and therapy interventions, or combinations of procedures and interventions, that are associated with better outcomes, controlling for patient characteristics. Aim 3: Determine whether specific impairment by treatment interactions are associated with better outcomes.